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Step 2 CS Diagnoses

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1. Headache DDX

- Migraine (complicated)
- Tension headache
- Cluster headache
- Pseudotumor cerebri
- Trigeminal neuralgia
- CNS vasculitis - Temporal Arteritis
- Subarachnoid hemorrhage (SAH)
- Partial seizure
- Intracranial neoplasm
- Sinusitis
2. Migraine Characteristics

Symptoms
- Unilateral throbbing
- Photophobia
- Sonophobia
- Aura
- Recurrent
Physical Exam
- No fever
- No weakness in extremities. -Numbness on one site of the body.
3. Cluster Headache

-Unilateral periorbital pain, often accompanied by ipsilateral nasal congestion, rhinorrhea, lacrimation,
redness of the eye, and/or Horner's syndrome.
- Episodes of daily pain occur in clusters.
- Sudden and intense.
- Last a couple of hours and gone.
- Recurrent same time of day.
- Often awaken patients at night.
- Rarely occurs in women (similarity seen in women is termed "chronic paroxysmal hemicrania").
Physical Exam
- Lacrimation.
- Blushing of Face.
4. Chronic Paroxysmal
Hemicrania

- Debilitating unilateral headache (usually around eye).


- Multiple severe, yet short, headache attacks. Women >> Men.
- No neurological symptoms associated with it.
Diagnosis with CPH: ≥ 20 attacks filling the following criteria:
- Attacks of severe unilateral orbital, supraorbital, or temporal pain lasting between 2 and 30 minutes.
• Headache needs to take place w/ 1 of the following:
- Ipsilateral conjunctival injection and/or lacrimation
- Ipsilateral nasal congestion and/or rhinorrhoea
- Ipsilateral eyelid edema
- Ipsilateral forehead and facial sweating
- Ipsilateral miosis and/or ptosis
• Attacks need to occur > 5 x day for more than half of the time
• Attacks can be prevented completely by therapeutic doses of indomethacin.
• Symptoms not due to another disorder and neuropathy of the supraorbital area in the temporal branch of
facial nerve r/p
5. Temporal
Arteritis

-Throbbing one-sided headache.


- Fever.
- Jaw pain** -
- Visual changes.
Physical Exam:
- Tender over temporal artery.
- Jaw pain when opening Jaw.
- Age over 50 years.
- May present with Polymyalgia Rheumatica (syndrome with pain or stiffness, usually in the neck, shoulders, and hips. The
pain can be very sudden, or can occur gradually over a period.)
6. Sinusitis

Symptoms
- Recent upper respiratory infection.
- Pain in cheek below eye.
- Dull, constant ache, worse leaning over.
- Nasal discharge and stuffiness.
- Rare cause of headache (w/o other symptoms).
Physical Exam
- Tenderness to palpation of maxillary sinus.
- No weakness in extremities.
7. Tension Headache

Symptoms
- Usually bilateral (bandlike) and squeezing.
- Last hours to days.
- Recurrent.
- Constant, not throbbing.
- Associated with stress .
- Gets worse as the day progresses.- Better with massage
Physical Exam
- Normal Vital Signs.
- Normal Neuro Exam.
8. Subarachnoid Bleed/Hemorrhage Symptoms
- Headache
- Syncope
- Very severe intensity
- First episode
- Vomiting
Physical Exam
- Mental status change
- Stiff neck
9. Intracranial Mass Lesion Symptoms
- 1/3 of patients with brain tumors present with primary complaint = headache.
- Headache = non-specific => mimics migraine.
- Certain brain tumors may have familial basis.
Physical Exam
- Mental status changes.
- Ataxia.
- Focal weakness.
- Visual Changes.
10. Psesudotumor Cerebri

Symptoms
- Headaches can be focal but usually accompanied by diplopia and other visual symptoms.
Physical Exam
- Should reveal papilledema (but can be normal during the first few days after onset of illness).
11. Trigeminal Neuralgia (TN) (aka tic - Pain accompanied by brief facial spasm or tic.
douloureux) - Pain distribution unilateral, follows branch of CN V (maxillary (V2) or mandibular (V3))
sensory distribution .
- P/E eliminates alternative diagnoses.
12. Depression headache Symptoms:
- Headaches may be worse on waking up in morning.
- Associated with other depression symptoms.
13. Glaucoma (closed angle) Symptoms:
- Pain centered over eye.
- First episode.
Physical Exam:
- Red Eye.
- Decreased visual acuity .
- Dilated pupil.
14. Confusion/Memory Loss DDX - Alzheimer's disease.
- Vascular Dementia (Vascular Multi Infarct Dementia).
- Normal Pressure Hydrocephalus (NPH).
- Creutzfeld-Jakob.
- Subdural Hematoma (SDH).
- Hypoglycemia.
- Depression with Pseudo Dementia.
- Hypothyroidism.
- Vit B12 deficiency.
15. Dementia vs Delirium

16. Dementia Types


17. Delirium

1. Disturbance of CONSCIOUSNESS (can't focus or shift attention).


2. Change in COGNITION (memory, language).
3. Develops over SHORT period of time and FLUCTUATES.
4. Caused by a general MEDICAL condition.
18. Vascular ("multi-infarct") dementia

- Often coexists with Alzheimer's Disease.


- Look at history of atherosclerotic vascular disease (i.e. stroke, MI) .
- Classically more step-wise deterioration in vascular dementia compared to steady
cognitive decline seen in Alzheimer.
- May be earlier loss of executive function and personality changes in vascular dementia.
19. Alzheimer's Disease

- Most common cause of dementia.


- Insidious onset with steady, progressive decline in cognitive function over years .
- Earliest findings are impairment in memory and visuospatial abilities.
- Clinical Diagnosis.
20. Alzheimer's Disease 5A's
(Confusion/Memory Loss DDX)
21. Normal Pressure Hydrocephalus
(NPH)

- Adams/Hakim Triad ("wet, wobbly and wacky").


1. Wet = Incontinence .
2. Wobbly = Gait ataxia (Wide-based).
3. Wacky = Dementia.
22. Creutzfeldt-Jakob Disease (CJD)

- Dementia, mood, anxiety, movement disorders.


- Rapidly progressive dementia; usually sporadic but can be rarely familial. Occurs in 7th
decade, fatal in 7 months.
- Caused by prions (small proteinaceous particle's that cause spongiform changes in the
brain)
23. Hypoglycemia (Confusion/Memory
Loss DDX)

Hypoglycemia Mnemonic:
T - Tachycardia.
I - Irritability.
R - Restless.
E - Excessive Hunger.
D - Diaphoresis/Depression.
- Autonomic: Anxiety, Palpitation, Sweating, Tingling, Trembling.
- Neuroglycopenia: Irritability, drowsiness, dizziness, blurred vision, difficulty with speech,
confusion, feeling faint.
24. Subdural Hematoma

Symptoms:
- History of Trauma.
- On warfarin.
- Headache.
Physical Exam:
- Mental status changes.
- Ataxia.
- Focal weakness.
- Visual Changes.
25. Depression with - Patient often tends to emphasize disability related to memory loss much more than patients
Pseudodementia experiencing true dementia.
- Appears to have dementia.
- Unable to remember correctly.
- Cannot calculate well.
- Complains, bitterly, of lost cognitive abilities or skills.
- High risk of progressing to dementia
- Depression or mild depressive symptoms can be comorbid.

Clues:
- Recent weight loss.
- Worsening sleep.
- Frequent crying spells.
- Self-deprecating comments.
- Recent-onset behavior changes (social withdrawal, psychomotor agitation, extreme negativism).
26. Vitamin B12 Deficiency

Symptoms:
- Lower Energy/Fatigue.
- Depression/Anxiety.
- Muscle pain.
- Irritability.
- Hearing and Vision problems.
- Mood disorders.
- Memory loss.
- Sexual problems/infertility.
27. Depressed Mood - Major Depressive Disorder.
DDX - Bereavement Disorder.
- Bipolar I and II Disorders.
28. Normal - 6 months - 18 months (normal).
Bereavement - Reaction to death of a loved one.
- Regards "depressed mood" as normal.
- May seek relief of insomnia or anorexia.
- Follows Major loss/event → normal → Patient relates sadness to loss → Intense sadness, pain.
- No significant loss of self-esteem.

DSM - V
- "Symptoms lasting less than 2 months since death of loved one" has been eliminated.
- Bereavement becomes Depression if suffering, feelings of worthlessness, suicidal ideation, poorer somatic
health, worse interpersonal and work functioning.
- Examples: Isolation of self from others, Work/marital/familial issues, patient planning to "meet" with dead
loved one (suicide), severe weight loss (ex. 25 lbs in 1 month not by medical condition).
29. Major Depressive
Disorder (MDD)

Last ≥ 2 weeks with ≥ 5 symptoms and MUST Include Depressed Mood or Anhedonia (loss of interest).

SIGECAPS
- Sleep disturbance (↑ or ↓).
- Interest Loss → MUST Include (or depressed mood).
- Guilt → Feeling worthless or inappropriately guilty .
- Energy Loss → Fatigue.
- Concentration Loss → impaired concentration or indecisiveness.
- Appetite (weight) changes (↑ or ↓).
- Psychomotor Changes (agitation or retardation).
- Suicidal ideation → thoughts of death.
30. Dysthymic Milder form of depression lasting at least 2 years → Not as severe or disabling.
disorder HE'S 2 SAD:
1. Hopelessness.
2. Energy loss or fatigue.
3. Self-esteem is low.
4. 2 years minimum of depressed mood most of day, for more days than not.
5. Sleep disorder (↑ or ↓).
6. Appetite change (↑ or ↓).
7. Decision-making or concentration impaired.
31. Bipolar
Disorder

Presence of at least 1 manic episode for at least 1 week (↑ Mood → cheerful, enthusiastic, Expansive or Irritable + ≥ 3
or 4 (if irritable) of 7 of DIGFAST)

• Manic = DIG FAST → ≥3 symptoms


1. Distractibility
2. Impaired judgment/ Indiscretion
3. Grandiosity
4. Flight of ideas
5. Activity ↑
6. Sleep deficit
7. Talkativeness

• Hypomania = TAD HIGH


1. Talkative
2. Attention deficit
3. Decreased need for sleep
4. High self-esteem/ grandiosity
5. Ideas that race
6. Goal-directed activity increased
7. High-risk activity
32. Cyclothymic 2 years (1-year in Children and Adolescents) of hypomania + mild depressive symptoms (not MDE).
Disorder
- Mildly depressed mood and Mild mania (cycles).
- No symptom-free period > 2 months.
- Dysthymia and Hypomania → milder form of bipolar disorder lasting at least 2 years.

- At least 2 years of hypomanic symptoms that DO NOT meet criteria for Manic Episode and numerous periods of
depressive symptoms that DO NOT meet the criteria for MDE
33. Psychosis - Schizophrenia.
DDX - Substance induced.
- Schizoaffective.
- Brief Psychotic Disorder.
- Psychosis sec. medical.
- Narcolepsy.
- Seizure.
34. Schizophrenia
(Psychosis DDX)

DSM-IV-TR Criteria → Period of psychosis > 6 months


• Criterion A: active-phase symptoms x 1 month
> 2 symptoms => Bizarre delusions or commenting/conversing hallucinations (1 only)
• Criterion B: Social or Occupational Dysfunction
• Criterion C: Duration of at least 6 Months
• Criterion D: Schizoaffective and Mood Disorder Exclusion
•Criterion E: Substance or General Medical Exclusion
• Criterion F: Relationship to a PDD

• Schizophrenia prototype is a patient who has psychotic symptoms and disturbed behavior lasting are present
for > 6 months → 2 of 5 symptoms →1. Delusions; 2. Hallucinations; 3. Disorganized behavior; 4. Disorganized
speech; and/or 5. Negative symptoms (flat affect, amotivation, etc.)

---
DSM-V Changes
- Two Criterion A symptoms now required for diagnosis
- One of criterion A symptoms must be one of three symptoms: Delusions, Hallucinations, or Disorganized
Speech
- Subtypes of Schizophrenia (Paranoid, Disorganized, etc.) are eliminated
35. Substance- Psychosis resulting from ingestion of medications, alcohol, illicit drugs, or may stem from the withdrawal of
induced alcohol or sedative drugs such as benzodiazepines
psychosis - Should be able to detect in work-up
(Psychosis DDX)
36. Schizoaffective - Mood episode and active phase symptoms of Schizophrenia occur together
Disorder - Proceeded and or followed by ≥ 2 weeks of delusions or hallucinations WITHOUT prominent mood symptoms
(Psychosis DDX) - Psychosis occurs concurrently with a mood episode
- Psychosis occurs without mood symptoms present
- Mood symptoms present for a substantial portion of the total duration of the illness (30% per some experts)
- Hallucinations or delusions present for ≥ 2 weeks in absence of prominent mood symptoms
- Types: (1) Bipolar Type (if mania → current or previous manic episode) or (2) Depressive Type (if only
depression)
DSM-V changes
Mood disorder must be present for more than the period of time the two Criterion A symptoms of Schizophrenia
has been found
37. Schizophreniform • > 1 month but < 6 months → symptoms last between 1 - 6 months
Disorder • Provisional diagnosis in patients who recovered
(Psychosis DDX) • Bizarre behavior, hallucination, paranoid, and delusion are present. However,
• Symptoms of schizophrenia i.e., usually 2 psychotic symptoms
38. Brief Psychotic Disorder (Psychosis DDX) Episode lasts: > 1 day but < 1 month with full remission
- Often precipitated by psychosocial factors
- Sudden onset of at least 1 positive symptom of schizophrenia
- Bizarre behavior, hallucination, paranoid, delusion
39. Dizziness DDX - Meniere's disease
- Orthostatic hypotension
- Drugs vs fluids
- Benign Positional Vertigo
- Vestibular Neuronitis
- Labyrinthitis
- Stroke
40. Ménière's Disease (Dizziness DDX) - Classically presents with recurrent episodic vertigo (usually lasting 1-8 hours) and
unilateral low-frequency hearing loss and tinnitus.
- Tinnitus and a sensation of aural fullness.
-Symptoms result from distension of the endolymphatic compartment of the inner
ear.
- Syphilis and heard trauma are two known causes.
41. Orthostatic hypotension due to dehydration - Risk factors = diuretics and diarrhea
(diarrhea, diuretic use) (Dizziness DDX)
42. Benign Paroxysmal Positional Vertigo Transient and brief vertigo following changes in head position but is not associated
(BPPV) (Dizziness DDX) with hearing loss. Dix-Hallpike Test causes nystagmus.
43. Vestibular Neuronitis (Dizziness DDX) - Can be a paroxysmal, single attack of vertigo, a series of attacks, or a persistent
condition which diminishes over two weeks.
-Acute onset of single episode that can last days.
- Associated with nausea, vomiting, and previous upper respiratory tract infections
- NO Hearing Loss - Generally has no auditory symptoms, unlike labyrinthitis.
- May also be associated with eye nystagmus.
-Pt falls down toward side of lesion. abnormal head thrust test.
- Due to inflammation of the vestibular nerve.
44. Labyrinthitis (Dizziness DDX) - Frequently follows viral infection (usually URI) and is accompanied by hearing loss
and tinnitus, but vertigo is usually continuous and lasts several days to a week
- HEARING LOSS
45. Acoustic Neuroma (Dizziness DDX) - More commonly causes continuous dysequilibrium rather than episodic vertigo
- Central lesions are unlikely in patients with vertigo, hearing loss and an otherwise
normal neurological exam
- Must r/o intracranial mass lesion in any patient with unilateral hearing loss.
46. Perilymphatic Fistula (Dizziness DDX) - Rare cause of vertigo and sensorineural hearing loss.
- Usually resulting from head trauma or extensive barotrauma.
- Episodes of vertigo are fleeting, generally lasting seconds.
47. Loss of Consciousness (LOC) DDX - Seizure, grand mal
- Vasovagal
- Cardiac arrhythmia
- Drug/orthostatic
- Convulsive syncope
- Aortic stenosis
48. Seizure Summary
(Syncope/LOC DDX)

- Seizures usually occur unpredictably in a manner unrelated to posture or exertion


- May stem from a variety of causes, including metabolic factors, trauma, vascular factors, and
brain tumors
- Tonic -clonic seizures are often accompanied by tongue biting, incontinence, and prolonged
confusion or drowsiness postictally
49. Seizure Types (Syncope/LOC
DDX)

Partial Seizures (Produced by a small area of the brain)


1. Simple (awareness is retained)
1a. Simple Motor = Jerking, muscle rigidity, spasms, head-turning
1b. Simple Sensory = Unusual sensations affecting either the vision, hearing, smell taste, or touch
1c. Simple Psychological = Memory or emotional disturbances
2. Complex (Impairment of awareness) = Automatisms such as lip smacking, chewing, fidgeting,
walking and other repetitive, involuntary but coordinated movements
3. Partial seizure with secondary generalization = Symptoms that are initially associated with a
preservation of consciousness that then evolves into a loss of consciousness and convulsions.

Generalized Seizures (Produced by the entire brain) - 6 Types


1. "Grand Mal" or Generalized tonic-clonic = Unconsciousness, convulsions, muscle rigidity
2. Absence = Brief loss of consciousness
3. Myoclonic = Sporadic (isolated), jerking movements
4. Clonic = Repetitive, jerking movements
5. Tonic = Muscle stiffness, rigidity
6. Atonic = Loss of muscle tone
50. Convulsive Syncope -Seizure-like activity often occurs after syncope and is due to global cerebral hypoperfusion
-There is no EEG correlate
-Shaking
-No subsequent confusion or weakness
51. Drug-Induced Orthostatic - Anti-hypertensive meds, diuretics, etc.. can cause orthostatic hypotesnion and syncope
Hypotension (Syncope/LOC - However, lightheadedness and syncope in this condition is usually postural (i.e., occurs when
DDX) getting up from a lying or seated position), and this patient's orthosttic vital signs were normal
52. Orthostatic Hypotension History
(Syncope/LOC DDX) - Alcohol ingestion
- Medication as cause
- Dehydration
Physical
- Tachycardia
- Hypotension when standing
- Advanced age
53. Vasovagal Syncope (Syncope/LOC - Emotional, Stressful situation/Pain ( may be due to excessive vagal tone with resulting
DDX) hypotension)
- Quick recovery in minutes
- No seizure activity
- Often heralded by nausea, sweating, tachycardia, pallor, and feeling "faint" (same mechanism
as posmicturation syncope)
54. Cardiac Arrhythmia(Syncope/LOC - Cardiac syncope typically occurs w/o warning, although a history of palpitations may
DDX) indicate the presence of underlying arrhythmias
- MI/Stroke = Increased risk for developing ventricular tachycardia
- Beta-blockers can contribute to bradyarrhythmia
History
- Palpitations
- Chest discomfort
- Shortness of breath
- Medication history
Physical
- Abnormal heart rate
- Irregular heartbear
55. Aortic Stenosis (Syncope/LOC DDX) - Commonly exertional or postecertional and occur w/o warning
History
- Shortness of breath
- Anginal chest discomfort
- Family history of same
Physical
- Age 60 and up
- Narrow pulse pressure
- Displaced PMI
56. Hypertrophic Cardiomyopathy - Commonly exertional or postexertional and occur w/o warning
(Syncope/LOC DDX) History
- Palpitations
- Dizziness
- Shortness of breath
- Younger athlete
- Family history
- Occurs with exercise

Physical Exam
- Heart Murmur
57. Numbness/Weakness DDX - TIA
- Stroke
- Guillain Barre
- MS
- DM peripheral
- Myasthenia Gravis
- Todds Paralysis
58. Signs and Symptoms of
Stroke
(Numbness/Weakness DDX)

Five Warning Signs:


1. Sudden Severe Headache → no apparent reason
2. Sudden weakness → Numbness and/or tingling in face, arm, or leg
3. Sudden dizziness → unsteadiness or sudden falls, especially with any of the other warning signs
4. Sudden vision trouble → sudden loss of vision (sight), particularly in one eye, or double vision
5. Sudden Speech trouble → Temporary loss of speech or trouble understanding speech
59. Guillain Barré
Syndrome(GBS)
(Numbness/Weakness DDX)

- Acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually


triggered by an acute infectious process.
-acute inflammatory demyelinating polyneuropathy (AIDP). - Severe and usually ascending paralysis
starting with lower limb (legs) weakness that ascends to upper limbs and face along with complete
loss of DTRs.
- Tx = plasmapheresis followed by immunoglobulins and supportive care.
60. Multiple Sclerosis (MS)
(Numbness/Weakness DDX)

- Nervous system disease that affects brain and spinal cord


- Damages the myelin sheath
- Damage slows down or blocks messages between your brain and your body
61. Diabetic Peripheral
Neuropathy
(Numbness/Weakness DDX)

- Symptoms = burning foot paresthesias, that are worse at night and loss of ankle reflexes
-diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum)
-Diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex;
diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal
neuropathy.
62. Myasthenia Gravis (MG)
(Numbness/Weakness DDX)

- Neuromuscular disease leading to fluctuating muscle weakness and fatiguability


- Autoimmune disorder → weakness d/t circulating antibodies that block AChR at post-synaptic
neuromuscular junction.
- Treated medically with cholinesterase inhibitors or immunosuppressants, and, in selected cases,
thymectomy
63. Todd's Paralysis - Focal weakness in a part of body after a seizure.
(Numbness/Weakness DDX) - Weakness typically affects appendages and is localized to either the left or right side of the body.
- Usually subsides completely within 48 hours
- Todd's paresis may also affect speech, eye position (gaze) or vision.
64. Peripheral Neuropathies

65. Fatigue/Sleepiness DDX - Depression


- Post-Traumatic Stress Disorder(PTSD)
- Colon Cancer
- Hypothyroid
- Obstructive Sleep Apnea (OSA)
- Diabetes Mellitus (DM)
- Sleep deprivation
66. Post-Traumatic Stress Disorder (PTSD)
(Fatigue/Sleepiness DDX)

TRAUMA
T - Traumatic event exposure
R - Re-experience (1+)
A - Avoidance (3+)
U - Unable to function
M - Month or more of symptoms
A - Arousal increased (2+)
67. Generalized Anxiety Disorder (GAD)
(Fatigue/Sleepiness DDX)

Worry WARTS
- Wound up
- Worn-out
- Absent minded
- Restless
- Touchy
- Sleepless
68. Adjustment Disorder (Fatigue/Sleepiness - Stress-related, short-term, nonpsychotic disturbance
DDX) - Disproportionately overwhelmed or overly intense in their responses to given
stimuli (divorce, new baby, move etc...)
- Begins w/in 3 months of stressor and symptoms lessen within 6 months upon
stressor removal or new adaptation occurs
69. Hypercalcemia (Fatigue/Sleepiness DDX)

- Hypercalcemia is a disorder that most commonly results from malignancy or


primary hyperparathyroidism.
- Other causes of ↑ calcium are less common and not considered until malignancy
and PTH disease are r/o
70. Hypothyroidism
(Fatigue/Sleepiness DDX)

- Usually primary hypothyroidism - ↓ Thyroid hormone (TH) but secondary = ↓ TSH secreation
or tertiary = ↓ TRH secretion
- In USA MCC - Autoimmune thyroid disease = Hashimoto thyroiditis

• Symptoms/Sings → AABBCDDEEFG H
- Arthralgia and Weakness/ Paresthesias/ Muscle Cramps → Peripheral Neuropathy and
Carpal Tunnel Syndrome
- Anorexia → Decreased Appetite
- Bowel → Constipation
- Bradycardia → Slow Heart Rate
- Cold Intolerance → Dressed Inappropriately for Ambient Temperature
- Depressed → Mental Clouding and Impaired Memory
- Delayed DTRs
- Energy → No Energy/Fatigue (Drowsiness)/ Lethargy→ Somnolence →Uninterested,
Immobile
- Eyebrows → Loss /thinning of lateral ⅓
- Facial →Periorbital puffiness
- Gain → Weight Gain
- Hair → Coarse/brittle hair, hair falling out
- Voice Hoarseness
- Swelling of face, hands, and legs
71. Obstructive Sleep Apnea (OSA)
(Fatigue/Sleepiness DDX)

- Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more
per hour.
• Cessation for >10 seconds → ↓ O2 saturation → Episodes of breathing cessation for 10
seconds during sleep, 10 - 15 events per hour with ↓ O2 saturation
o Associated signs → Snoring, gasping, GI reflux (GERD), nocturia, excessive moving, night
sweats, morning headaches, daytime sleepiness, sleep attacks
o Psychological: Slow thought process, memory impairment, inattention
72. Diabetes Mellitus (Fatigue/Sleepiness
DDX)

- Polyuria, Polydipsia, Polyphagia** (either DM or DI → DM = glucose in urine, high


specific gravity, DI → dilute urine)
- ↑ Blood sugar symptoms = frequent urination, ↑ thirst, and ↑ hunger
- Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar
coma.
73. Diabetes Insipidus (DI) - Excretion of large amounts of severely diluted urine, which cannot be reduced when
(Fatigue/Sleepiness DDX) fluid intake is reduced.
- Denotes inability of the kidney to concentrate urine.
- DI is caused by a deficiency of antidiuretic hormone (ADH), aka vasopressin, or by an
insensitivity of the kidneys to that hormone
- It can also be induced iatrogenically by the diuretic conivaptan
74. Sleep Deprivation (Fatigue/Sleepiness
DDX)

Sleep deprivation is a general lack of the necessary amount of sleep. This may occur as
a result of sleep disorders, active choice or deliberate inducement such as in
interrogation or for torture.
75. Night Sweats DDX - Tuberculosis (TB)
- Acute HIV infection
- Lymphoma
- Leukemia
- Hyperthyroidism
76. Night Sweats Work- - PPD
Upvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv - Chest X-ray (CXR)
- CBC with diff
- Sputum Gram Stain and Acid Fast Stain
- (Bronchoalveolar lavage (BAL))
77. Tuberculosis (TB) (Night
Sweats DDX)

- History: Chronic cough, Hemoptysis, Weight loss, Exposure to TB, Night Sweats
- Physical Exam: Fever, lung findings, low weight
78. Acute HIV Infection (Night
Sweats DDX)

• Primary/Acute HIV infection occurs 2 - 4 weeks after infection with the human immunodeficiency virus
(HIV).
• Virus is spread by:
- Breastfeeding (rarely)
- Contaminated blood transfusions and blood products
- Intravenous (IV) drug use with contaminated needles and syringes
- Passing through the placenta from the mother to the fetus
- Sexual contact
• HIV seroconversion (converting from HIV negative to HIV positive [HIV Abs detected in blood]),
occurs w/in 3 months of exposure (can be up to 1 year)
• Following the acute infection, there may be no further evidence of illness for the next 10 years.
79. Insomnia DDX - Stress
- Caffeine
- Major Depressive Disorder (MDD)
- Obstructive Sleep Apnea
80. Insomnia

• State of hyperarousal
• CC = Dissatisfaction with sleep quantity or quality, associated with ≥1 following symptoms:
- Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver
intervention.)
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after
awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
- Early-morning awakening with inability to return to sleep.
- ≥ 3 nights per a week for ≥ 3 months with adequate opportunity to sleep
- Caffeine0induced insomina = MC pharm cause of insomnia
- People w/ OSA, >50% complain of insomnia sx
81. Sore Throat DDX - Infectious mononucleosis
- Pharyngitis (bacterial (strep) or viral)
- Acute HIV infection
- Streptococcal tonsillitis/scarlet fever
- Atypical Pneumonia (Mycoplasma pneumonia)
82. Infectious
Mononucleosis (Sore
Throat DDX)

- MC in adolescents and young adults


- Sx = Teen w/ fever, sore throat, muscle soreness, malaise, and fatigue.
→ Central sx = Fatigue, Malaise, Appetite loss, Headache
→ Visual sx = Photophobia
→ Tonsils sx = Erythema, Swelling, White patches
→ Throat sx = Erythema and Soreness
→ Lymph nodes= CERVICAL LAD
→ Respiratory sx = Cough
→ Splenomegaly
-Abdominal pain
→ Gastric sx = Nausea
→ Systemic sx = Chills, Fever, and Aches

- ~90% of people will acquire EBV no symptoms


- Mononucleosis is usually caused by the Epstein-Barr virus (EBV), which infects B cells (B-lymphocytes),
producing a reactive lymphocytosis and atypical T cells (T-lymphocytes) known as Downey bodies.
83. Strep Tonsillitis/ Scarlet
Fever (Sore Throat DDX)

• Caused by an exotoxin released by Streptococcus pyogenes Group A


• Presentation = sore throat, fever, a 'strawberry' tongue, and a fine sandpaper rash over upper (or
entire) body
- Day 1 = Abrupt onset → Sore throat, reddened fauces, Punctate, bright red rash on hard palate =
Coated "strawberry tongue"
- Day 2 = Polymorphonuclear leukocytosis. Eosionphiles increased
- Day 3 = Flushed cheeks, Punctate blush over neck and chest spreading to entire body. Rash is fine,
red, w/ rough-textures, blanches; Pastia lines in armpits and goin, appear (can last after rash gone)
- Day 4 = Desquamation (peeling) begins

• Scarlet Fever ≠ Rheumatic Fever, but may progress into RF.


• Treat with Penicillin G or Clindamycin to prevent RF (will not prevent post-streptococcal
glomerulonephritis)
84. Pharyngitis (bacterial (strep)
or viral) (Sore Throat DDX)

- Painful inflammation of pharynx


- Infection of the tonsils (tonsillitis) and/or larynx (laryngitis) may occur simultaneously.
- ~90% of cases are caused by viral infection, with the rest d/t bacterial infection and, in rare cases,
oral thrush (fungal candidiasis e.g. in babies).
- Some cases of pharyngitis are caused by irritation from elements such as pollutants or chemical
substances.
85. Cough/Shortness of Breath - Asthma (especially Exercise-Induced Asthma)
(SOB) DDX - Chronic Obstructive Pulmonary Disease (COPD) - Chronic Bronchitis
- COPD Exacerbation
- Pneumonia
- Atypical pneumonia
- Lung Neoplasm/Cancer
- Tuberculosis (TB)
- Congestive Heart Failure (CHF)
- ACE inhibitors use
- Paroxysmal Nocturnal Dysnea (PND)
- Gastroesophageal Reflux Disease (GERD)
- HIV
86. Asthma (Cough/SOB DDX)

Characterized by hyper-responsiveness, mucosal edema, and mucus production.


• Recurrent episodes: cough, chest tightness, wheezing, and dyspnea
• Hx: Recurrent attacks of dyspnea, cough, wheezing, Hx or FH of asthma
• Phy: Wheezing (Expiratory high-pitched whistling sound made during breathing)
87. Exercise Induced Asthma (Cough/SOB • During normal breathing via nose → warms and moistens air
DDX) • When exercise breathe via mouth → inhale colder and drier air
• Exercise-induced asthma, muscle bands around airways sensitive to these changes in
temperature and humidity → contract → airway narrows
• Sx begin 5 - 20 min after exercise started and stop 5 - 10 min after exercise stopped →
Sx =
- Coughing with asthma
- Tightening of the chest
- Wheezing
- Unusual fatigue while exercising
- SOB when exercising
88. Chronic Obstructive Pulmonary Disease
(COPD) - Chronic Bronchitis
(Cough/SOB DDX)

Characterized by persistent airflow, limitation that is usually progressive and associated


with an enhanced chronic inflammatory response in the airways and the lung to noxious
particles or gases.
- HX: Dyspnea, Cough, Weight loss, Pursed lip breathing, Chronic condition, Smoking
history
- PE: Rales in lungs, Gallop heart rhythm, Distended neck vein, Distended liver
- COPD exacerbation have ↑ sputum production and cough
89. Pneumonia (Cough/SOB DDX)

- Classical bacterial pneumonia begins with abrupt onset of fever, chills, pleuritic chest pain and
productive cough (sputum production)
- Pleuritic pain may signal lower respiratory tract infection (diagnosis confirmed via chest exam)
- Physical Exam: Fever, dullness to percussion, abnormal breath sounds, ↑ tactile fremitus
- Signs of pulmonary consolidation on physical exam are absent 2/3s of time
90. Atypical Pneumonia (Sore Throat • Anyone at any age can get walking pneumonia.
or Cough/SOB DDX) • Caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella species
• M. pneumoniae is a common cause of mild pneumonia that usually affects people younger
than 40
• People who live and work in crowded places, i.e. schools, homeless shelters, prisons →
↑ risk contracting it
• Spread via resp. droplets → sx appear 15 - 25d after exposure to mycoplasma and develop
slowly over 2 - 4 days
• Symptoms include:
- Non-Productive Cough → may come in violent spasms but produce very little mucus
- Fever, Malaise Headache, Myalgia → Mild flu-like symptoms such as fever and chills
- Sore throat/Hoarseness
- Headache
- Tiredness
- Chest pain
- Lingering weakness may persist after other sx gone

- Sputum may be blood-streaked


- GI sx prominent in Legionella infection
- Severe ear pain d/t bullous myringitis may complicate up to 5% of Mycoplasma infections
91. URI-Associated Cough - Acute cough frequently follows URI ("postinfectious") and can commonly persist for 1-2 weeks
(Cough/SOB DDX) (or up to 6-8 weeks in patients with underlying asthma)
- Causes range form rhinosinusitis to acute bronchitis
92. Pleurodynia (Cough/SOB DDX) - Uncommon acute illness usually caused by one of the coxsackieviruses
- Occurs in summer and early fall and presents with acute severe paroxysmal pain of thorax or
abdomen that worsens with cough or breathing
- Most patients recover within 3 days to 1 week
93. Bronchiectasis (Cough/SOB DDX) Localized, irreversible dilatation of part of bronchial tree
- Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction
and impaired clearance of secretions
- Associated with a wide range of disorders, usually from necrotizing bacterial infections, i,e,
Staph, Klebsiella sp., or Bordetella pertussis
94. Lung Cancer/Neoplasm
(Cough/SOB DDX)

History: Hx of smoking, Cough, Chest pain, shortness of breath, hemoptysis


Physical exam: Weight loss, wheezing
95. Lung Abscess (Cough/SOB DDX) - D/t anaerobic bacteria
- Usually associated with gradual onset of fatigue, fever, night sweats, cough producing a foul-
smelling expectoration, and weight loss
- Evolves over weeks to months
96. Congestive Heart Failure (CHF)
(Cough/SOB DDX)

-Congestive heart failure can be caused by diseases that:


- History: Dyspnea on exertion, pedal edema, orthopnea, hx of HTN, smoking, coronary
disease
- Physical: Rales in lungs, gallop heart rhythm, distended neck vein, distended liver
97. Allergic Rhinitis (Chronic Cough - History: Runny Nose, Itchy watery eyes, recurrent with season
DDX) - Physical Exam: Rhinorrhea, Watery eyes, Allergic shiners
98. ACE Inhibitor Use (Chronic Cough - History: Taking ACE Inhibitor, Dry and non-productive cough
DDX) - Physical Exam: No fever, normal lung exam
99. Anemia (SOB DDX)

History: Fatigue, Generalized Weakness


Physical Exam: Pallor
100. Airway Obstruction (SOB DDX) - History: Sudden onset, change to voice, choked on food or denture
Physical Exam: Stridor, Cyanosis
101. Anaphylaxis
(SOB DDX)

- History: Acute SOB, Wheezing, Hx of exposure to allergen


- Physical Exam: Hives, Hypotension, Tachypnea, Tachycardia
102. Chest Pain - Myocardial Infarct (MI)
DDX - Sickle Cell Disease - Pulmonary Infarct
- Gastroesophageal Reflux Disorder (GERD)
- Angina
- Pericarditis
- Costochodritis
- Pulmonary Embolism (PE)
- Aortic dissection
- Cocaine induced
103. Myocardial
Infarction (MI)
(Chest Pain
DDX)

History: Substernal chest pain, dyspnea, nausea, hx of smoking, HTN


Physical Exam: Diaphoresis (list any abnormal vital signs)
104. Pneumothorax
(Chest Pain
DDX)

History: Pleuritic unilateral chest pain, Sudden onset, SOB


Physical Exam: ↑ HR, ↑ RR, ↓ unilateral breath sounds, ↓ tactile fremitus
105. Sickle Cell - In sickle cell disease, an initial trigger (often infection) exacerbated by dehydration (i.e., d/t fever, tachypnea, or
Pulmonary ↓intake) leads to sickling of RBCs within small blood vessels of lung → precipitates a cycle of relative
Infarct (Chest deoxygenation that further exacerbates the sickling tendency, leading to small vessel occlusion and, ultimately,
Pain DDX) infarction of areas of the pulmonary parenchyma.
- Allied to this sequence is the tendency of many patients with sickle cell disease to have a component of reactive
airways disease, which further decreases oxygenation.
106. Acute Coronary Syndrome - History: Heavy substernal pressure feeling, shortness of breath, Nausea, Diaphoresis, Lasts minutes
(Chest Pain DDX) to starting coupe hours ago
- Physical Exam: Diaphoretic, Abnormal vital signs, No high fever
107. Gastroesophageal Reflux
Disease (GERD)(Chest Pain
DDX)

History: Heartburn, Sour taste coming up to mouth, Pregnant, Better with Antacids
Physical Exam: No fever, No pleuritic pain, No abdominal pain

Severe chest pain is atypical presentation but not uncommon for GERD and may worsen with
recumbency overnight. Other atypical symptoms may include chronic cough, wheezing, or dysphagia
- Classic sx of GERD is heartburn, which may be exacerbated by meals
108. Angina (Chest Pain DDX) • Angina pectoris, chest pain d/t ischemia (lack of blood, hence O2 supply) of heart muscle

- One common form of Angina is chest pain or discomfort that occurs when your heart isn't getting
enough oxygen because of reduced blood flow to heart. It is usually a symptom of coronary heart
disease.

• Abdominal angina, postprandial abdominal pain that occurs in individuals with insufficient blood
flow to meet visceral demands

• Ludwig's angina, a serious, potentially life-threatening infection of the tissues of floor of mouth

• Prinzmetal's angina, a syndrome typically consisting of cardiac chest pain at rest that occurs in
cycles

• Vincent's angina, trench mouth, infection of the gums leading to inflammation, bleeding, deep
ulceration and necrotic gum tissue

• Angina tonsillaris, an inflammation of the tonsils

• "Angina" (song) is also the name of a single by the Gothic metal band Tristania
109. Pericarditis (Chest Pain -Can occur as a complication of infections, immunologic conditions, or heart attack
DDX) - History: Pain better sitting up and leaning forward, Pleuritic pain, Started after viral URI
- Physical Exam: Cardiac rub, Fever
110. Costochondritis (Chest Pain - History: Sharp pain, Hurts with movement and twisting
DDX) - Physical Exam: Point tenderness causing the pain
111. Herpes Zoster (Chest Pain - History: Unilateral, paresthesia of skin unilateral dermatone
DDX) - Physical Exam: Unilateral blistering rash on a dermatome fever
112. Pulmonary Embolism (Chest - History: Pleuritic Chest pain, SOB, Unilateral swollen lower left, Hx of DVT in past, Not on warfarin
Pain DDX) - Physical Exam: Tachycardia, Tachypnea, No pain to palpation of chest wall, unilateral swollen leg
113. Aortic Dissection (Chest History: Ripping Chest Pain, Sudden onset, Pain may migrate to neck or back
Pain DDX) Physical Exam: Blood pressure difference between arms, Heart murmur (if aortic insufficiency), pulse
differences between sides
114. Acute Cardiovascular Illness (Mycoardial infarction, pulmonary - History: Vomiting, Chest pain, Back pain, SOB
embolism, aortic dissection) - Physical Exam: ↑ RR, Heart murmur, unequal pulse
115. Palpitation DDX - Hypoglycemia
- Cardiac Arrhythmias
- Hyperthyroidism
- Panic Attacks
- Pheochromocytoma
- Carcinoid Syndrome
- Angina
- Hyperventilation Episodes
- Generalized Anxiety Disorder
- Agoraphobia/Social Phobia
- Substance Abuse/Dependence
116. Hyperthyroidism (Palpitations DDX)

Symptoms
- Heat Intolerance → Excessive sweating and heat
intolerance
- Weight Loss → despite ↑ Appetite
- Diarrhea → Frequent bowel movements
- Nervousness
- Emotional Liability
- Poor Concentration
- Palpitations
- Swelling of Eyes
- Double of Vision
- Weakness and Fatigability

• Signs
- Dressed Inappropriately for Ambient Temperature
- Weight Loss
- Hyperactive
- Fidgety, Restless
- Tremors of hand
- Tachycardia/Afib
- Periorbital Edema
- Opthalmoplegia → Diplopia
- Exopthalmos/Proptosis
- Lid Retraction, Lid Lag
- With Graves' disease, eye signs such as stare, lid lag,
and exophthalmos
- Proximal Muscle Weakness
117. Panic Attacks (Palpitations
DDX)

PANIC DISORDER
- Recurrent unexpected panic attacks
- ≥ 1 of the attacks followed by ≥ 1 month of ≥ 1 of the following:
1. Persistent concern about additional attacks=Anticipatory anxiety
2. Worries about implications of attack or its consequences
3. Avoidance
• Panic Disorder without Agoraphobia
- Persistent worry/concern about additional attacks or their consequences
• Panic Disorder with Agoraphobia
- Meets criteria for panic disorder Fear/AVOIDANCE of situations where panic attacks might occur
118. Pheochromocytoma - Rare catecholamine-secreting tumor derived from chromaffin cells.
(Palpitations DDX) - Tumors arise outside the adrenal gland are termed extra-adrenal pheochromocytomas or
paragangliomas b/c of excessive catecholamine secretion
- May precipitate life-threatening hypertension or cardiac arrhythmias.
- Check Urine catecholamines
119. Carcinoid Syndrome - Serotonin overproduction
- Most commonly found in the foregut (35.6% cases) with lung, bronchus and trachea constituting 27.9%
cases.
Sx = Cutaneous flushing accompanied by sweating, GI hypermotility → causing diarrhea,
Bronchospasm
- Increased 5-HIAA excretion of in urine
120. Social Phobia (Palpitations • Marked fear/avoidance of social situations due to the possibility of embarrassment or humiliation
DDX)
121. Weight Loss DDX - Hyperthyroid
- Cancer
- HIV
- Diet
- Drugs
- Anorexia
- Malabsorption
122. Weight Gain DDX - Smoking cessation
- Drugs (Lithium)
- Hypothyroidism
- Cushing's Syndrome/Disease/Syndrome
- PCOS
- DM
- Atypical depression
- Familial
- Pregnancy
123. Dysphagia DDX - Esophageal cancer
- Plummer-Vinson
- Achalasia
- Esophagitis
124. Esophageal Cancer (Dysphagia • Squamous Cell Carcinoma (SCC).
DDX) - More common worldwide → d/t slow passage of food through esophagus
- Men >50, Asians. Upper 2/3 of esophagus → D/t: => Diet (Nitrosamines, ↓Vit. A, riboflavin): ↑
exposure to carcinogens (tobacco/alcohol)
=> Lifestyle (smoking, etOH),
=> Genetic (celiac, tylosis). p53 mutation (no KRAS/APC mutations)
=> Esophageal disease (Plummer-Vinson/Patterson Brown Kelly, achalasia).
- Sx: Dysphagia to solid foods, wt. loss, chest pain, cough.
- Spreads via LN. Exophytic, infiltrative, excavated

• Adenocarcinoma (ADC).
- More common in US. Median age 50. More common in whites. Lower 1/3 of esophagus
- All ADC due to Barret's esophagus Assoc'd with lifestyle (obesity + alcohol)
- Sx: Dysphagia to solid foods, wt. loss, chest pain, cough.
- Most = mucin producing. Poor prognosis.
- Surveillance in Barrett's esophagus = mandatory
125. Plummer-Vinson Syndrome - Can occurs in people with long-term (chronic) iron deficiency anemia
(Dysphagia DDX) - Condition have problems swallowing due to small, thin growths of tissue that partially block the
upper food pipe (esophagus)
- Difficulty swallowing
- Weakness
- Has been linked to esophageal cancer
126. Achalasia/Cardiospasm Incomplete relax of LES in response to swallowing.Esophagus dilates above LES.
(Dysphagia DDX) 1° - Myenteric plexus (Auerbach) ganglion cells absent in esophagus → ↓ LES relaxation
2° - Chagas disease: T. cruzi (can also cause acq'd megacolon) → ↑ LES Tone
CREST syndrome/scleroderma ("E" in CREST = Esoph. dysmotility)
127. Esophagitis (Dysphagia DDX) • Irritation or inflammation of the esophagus
• Can be painful and can make it hard to swallow
• Common symptoms of esophagitis include:
- Heartburn
- Pain when you swallow
- Trouble swallowing food or liquids
- Chest pain (may be similar to the pain of a heart attack)
- A cough.
• Sometimes it also causes:
- Nausea or vomiting
- Fever
- Belly pain
128. Scleroderma/CREST (Dysphagia
DDX)

129. Hiatal Hernia (Dysphagia DDX) Herniation of stomach through enlarged esophageal hiatus in diaphragm.
- 95% Axial/Sliding: Incompetent LES → bell-shaped dilation → gastric reflux epigastric pain,
heart burn, respiratory distress
130. Mallory Weiss Syndrome - Mucosa: longitudinal Lesions: tears @ esophageal-gastric junction. Acute.
(Dysphagia DDX) - Due to severe retching in alcoholics/bulemics.
- Inadequate relaxation of LES during vomiting → stretching/tearing @ esoph-gastric junction
- PAIN + Hematesis
131. Nausea/Vomiting DDX - Pregnancy
- Gastritis
- Hypercalcemia
- DM
- UTI
- Infection - Gatroenteroritis
- Bowel Obstruction (Large or Small)
132. Abdominal Pain DDX - Pancreatic Cancer
- Acute Pancreatitis
- Acute Cholecystitis
- Ascending Cholangitis
- Acute Hepatitis
- PUD
- Perforated ulcer
- Splenic rupture
- Intestinal Obstruction
- Mesenteric Ischemia
- Ovarian Torsion
- Diverticulitis
- Appendicitis
- IBS
- PID
- Stomach Cancer
- Func. Dyspepsia
133. Nephrolithiasis (Abd Pain Sudden onset, very severe and colicky, intermittent, not improved by changes in position, radiating
DDX) from the back, down the flank, and into the groin.
- Pain may be felt in the belly area or side of the back.
- Pain may move to groin area (groin pain) or testicles (testicle pain).
- Other symptoms can include:
--> Abnormal urine color
--> Blood in the urine
--> Chills
--> Fever
--> Nausea
--> Vomiting

Pyelonephritis = ascending UTI that reached kidney's pyelum (pelvis) --> severe infection = urosepsis
--> form of nephritis. It can also be called pyelitis
134. Pancreatic Cancer
(Ab Pain DDX)

- Upper abdominal pain that may radiate to your back


- Bloating. Some people with pancreatic cancer have a sense of early fullness with meals (satiety) or an
uncomfortable swelling in the abdomen.
- Nausea
- Diarrhea
- Pale-colored stools. If the duct draining bile into the intestine is blocked by pancreatic cancer, the stools
may lose their brown color and become pale or clay-colored. Urine may become darker.

- Yellowing of your skin and the whites of your eyes ( jaundice)


- Itching => blockage of bile ducts response
- Loss of appetite
- Weight loss
- Depression
- Blood clots
- Elevated blood sugars. Some people with pancreatic cancer develop diabetes since cancer impairs the
pancreas' ability to produce insulin (not all new onset of diabetes = pancreatic cancer)
135. Acute Pancreatitis - Severe epigastric pain radiating to the back
(Ab Pain DDX) → May be worse few minutes w/in eating/drinking esp. high fat content
→ May radiate to back and below left shoulder
- Nausea /Vomiting
- Loss of appetite
- Fever/- Chills (shivering)
- Clay colored stools
- Gaseous abdominal fullness
- Hiccups/- Indigestion
- Mild yellowing of the skin and whites of the eyes ( jaundice)
- Swollen abdomen/- Peritonitis
- Grey-Turner's sign (hemorrhagic discoloration of the flanks)
- Cullen's sign (hemorrhagic discoloration of the umbilicus)
136. Peptic Ulcer - First sign is often sudden intense abdominal pain
Perforation (Ab Pain - Perforation at anterior surface of stomach leads to acute peritonitis, → initially chemical and later bacterial
DDX) peritonitis
- Posterior wall perforation leads to bleeding due to involvement of gastroduodenal artery that lies
posterior to 1st part of duodenum.
137. Ruptured Ovarian - Ovarian cyst = any collection of fluid, surrounded by a very thin wall, within an ovary.
Cyst (Ab Pain DDX) - Any ovarian follicle that is > ~2cm = ovarian cyst (Ovarian cyst can be as small as a pea, or as large as a
cantaloupe.)
- Most ovarian cysts are functional in nature, and harmless (benign)
- In the US ovarian cysts are found in nearly all premenopausal women, and in up to 14.8% of
postmenopausal women.
- Incidence of ovarian carcinoma is approximately 15 cases per 100,000 women per year
- Ovarian cysts affect women of all ages.
- Most often, however, during a woman's childbearing years.
- Some ovarian cysts cause problems, such as bleeding and pain, may need surgical removal
138. Fitz-Hugh-Curtis - Rare complication of PID
syndrome (Ab Pain DDX) - Usually caused by gonorrhoea (acute gonococcal perihepatitis) or chlamydia bacteria, which cause a
thinning of cervical mucous and allow bacteria from the vagina into the uterus and oviducts, causing
infection and inflammation.
- Occasionally, inflammation can affect Glisson's capsule, a thin layer of connective tissue surrounding
the liver.
- Signs are acute onset, RUQ Ab pain and tendereness aggravated by breathing, coughing or
movement, and referred to the right shoulder following an episode of PID
- Laparoscopy may reveal "violin string" adhesions.
- Treatment involves diagnosing and treating the underlying cause correctly. The adhesions can be cut
laparoscopically
139. Constipation/Diarrhea - Colorectal Cancer
DDX - Low-Fiber Diet
- IBS
- Infectious Diarrhea
- C Diff colitis
- Travelers Diarrhea
- Lactose intolerance
- Crohn's Disease
- UC
140. Colon Cancer • Microcytic Anemia lab → seen in Adult male or post-menopausal women = Colon Cancer until
(Constipation/Diarrhea, otherwise proven
Blood in Stool DDX) • Right Sided → Insidious
- No Gross blood in stools
- Fatigue
- Anorexia
- Weight loss
- Abd discomfort
- (don't see constipation b/c R side = unformed (loose stools))
• Left Sided → Gross blood
- Change in bowl habit
- Pencil thin stools
- Constipation
- Alternating Constipation and Diarrhea
- Sensation of incomplete emptying
- Sensation of Fullness
141. Upper GI (UGI) Bleeding - Peptic Ulcer Disease
DDX - Gastritis
- Varices
- Mallory Weiss
- Cancer
142. Blood in Stool DDX - Colon Cancer
- Ulcerative Colitis
- Diverticulosis
- Hemorrhoids
- Crohns Disease
- Angiodysplasia
- Ischemic Bowel
- Dysentery
-Pseudomembranous colitis
143. Hematuria DDX - Bladder Cancer
- PKD
- Renal cell carcinoma
- Nephrolithiasis
- Glomerulonephritis
- Pyelonephritis
- Coagulatuib disorder
144. Erectile - Drugs
Dysfunction (ED) - Hypertension
DDX - Diabetes Mellitus
- Psychogenic
- Peyronie's disease (induratio penis plastica (IPP) or chronic inflammation of the tunica albuginea (CITA)) -
connective tissue disorder involving the growth of fibrous plaques
145. Amenorrhea DDX - Pregnancy
- PCOS
- Prolactinoma
- Menopause
- Sheehan's
- Anorexia
- Anxiety
- Asherman's
- Hypothyroid
146. Vaginal Bleeding
DDX

- Dysfunctional Uterine Bleeding (DUB)


- Endometrial Cancer → Post-menopausal bleeding = endometrial cancer until otherwise proven
- Cervical Cancer → intermenstrual or post-coital bleeding r/o cervical cancer
- Spontaneous Abortion
- Ectopic Pregnancy/Rupture
- Trauma
- Endometrial Hyperplasia
- Molar Pregnancy
- Ruptured Uterine Pregnancy
147. Vaginal Discharge - Bacterial Vaginosis
DDX - Vaginitis (trich vs candida)
- Cervicitis
148. Chlamydia/Gonorrhea Discharge (Vaginal Chlamydia Trachomatis
Discharge DDX) - Asymptomatic (50% of men, 80% of women)
- Urethritis and proctitis in men
- Vaginal discharge, dysuria, dyspareunia, lower abdominal pain, IMB or PCB
in women.

Neisseria Gonorrhea
- Asymptomatic
- Urethritis (dysuria)
- Discharge (purulent)
- In men only: fever, sweating, proctitis, pharyngitis.
149. Dyspareunia (Painful Intercourse) DDX - Atrophic vaginitis
- Endometriosis
- Cervicitis
- Domestic Abuse
- Vaginismus
- PID
- Abuse
- Depression
- Vulvovaginitis
- Vulvodynia
150. Abuse DDX - Domestic Violence
- Osteogenesis Imperfecta
- Substance abuse
- Rape
- Consensual violent sex
151. Joint/Limb Pain DDX - Rheumatoid Arthritis (RA)
- Systemic Lupus Erythematosus (SLE)
- Domestic Violence
- Carpal Tunnel
- Psoriatic Arthritis
- Fracture
- Dislocation
- Osteoarthritis (OA)
- Septic Arthitis
- Stress Fracture
- Inflammation
- Peripheral Vascular Disease (PVD)
- Deep Vein Thrombosis (DVT)
- Myocardial Infarction (MI)
- Rhabdomyolysis
152. Differing presentation of RA vs. OA

RA - morning stiffness > 30 min (worst in the AM)

OA - short morning stiffness but usually gets worse THROUGHOUT THE DAY

RA joints - hands, wrists, elbows, shoulders, ankles, hips, knees, CERVICAL spine

OA joints - DIP, PIP, weight bearing joints (hip, knee), ANY SPINE

MAJOR DISTINCTIONS:
RA - only cervical spine; no DIP; PIP
OA - lumbar or cervical spine; DIP; PIP
153. Low Back Pain DDX - Disk herniation
- Lumbar muscle strain
- Lumbar spinal stenosis
- Malingering
- Ankylosing Spondylitis
- Cancer
- AAA
154. Child with Fever - Sepsis
- Meningitis
- Pneumonia
- UTI
- Acute otitis Media
- URI
- Viral exanthem
- Gastroenteritis
- Volvulus
- Intussueption
- Food poisoning
155. Behavioral Problems DDX - ADHD
- Adjustment disorder
- ODD
- Childhood BPD
- Substance abuse
- Age appropriate behavior
156. Child with seizure -Simple febrile seizure
-Meningitis
-Hyponatremia
-UTI
-Occult bacteremia
157. Child with -Viral gastroenteritis
diarrhea -Bacterial diarrhea
-Malabsorption
-UTI
-Intussusception
-Bacteremia
158. Hand tremor -Parkinson's disease
-Essential tremor
-Physiologic tremor
-Drug induce tremor
-Psychogenic tremor
-Hyperthyroidism
159. Cough -Pneumonia
-Lung cancer
-COPD
-TB
-Lung abscess
-Atypical pneumonia
160. Child with noise -Foreign body aspiration
while breathing -Croup
-Epiglottis
-Laryngitis
-Retropharyngeal abscess
-Peritonsillar abscess
161. Acute otitis Fever, irritability, headache, apathy, disturbed or restless sleep, poor feeding/anorexia, vomiting, and diarrhea.
media Otalgia, URI is a risk factor.
162. Meningococcal Fever, lethargy, and a possible petechial rash suggest meningococcemia. Patients may also have headache,
meningitis vomiting, photophobia, neck
stiffness, and seizures. Meningococcal vaccinations are typically not given
until 11-12 years of age; is a severe,
rapidly progressive, and sometimes fatal infection.
163. Scarlet fever Fever, difficulty swallowing (possible pharyngitis), and a rash like a diffuse erythema with punctate, sandpaper-like
elevations that spare the area around the mouth. In addition, scarlet fever is more common among school-age
children.
164. Varicella Fever and rash, along with day care attendance, are consistent with this
infection. In varicella, lesions are present in various stages of development at any
given time (eg, red macules, vesicles, pustules, crusting), and the rash is intensely
pruritic.
165. Foreign body Sudden and dramatic onset of symptoms, especially when a foreign body (usually a toy or peanuts) is in the
aspiration vicinity before the patient develops symptoms, breathing noisily and is experiencing some shortness of breath,
both of which are consistent with aspiration of a foreign body.
166. Croup Common in children six months to three years of age, usually developing insidiously as a URI. Low-grade fever
for the a week, a characteristic barking cough is often present in croup.
167. Epiglottitis Occurs more frequently in children 2-6 years of age, and begins with Its hallmark feature, significant drooling
with symptomatic relief
while bending forward, hoarseness.
168. Retropharyngeal Patients are usually younger than six years of age. Lack stridor, voice is muffled, and drooling is often present.
abscess